NEW
STUDY: MEDICAID EXPANSIONS REPRESENT BEST WAY TO STOP EROSION OF HEALTH INSURANCE
COVERAGE FOR WORKING POOR PARENTS; BUT PRICE TAG IS IN THE BILLIONS

Extending Coverage
to Parents Could Help Improve Access to Care for Children – Even Those
Already Eligible for SCHIP

Bethesda, MD—Unless states expand Medicaid and the State
Children’s Health Insurance Program (SCHIP) to offer coverage to low-income
parents it is unlikely that parents living in poverty will gain health insurance
coverage. In fact, coverage for the working poor will likely continue to erode,
according to a study
released today in the March/April issue of the journal Health Affairs.

The authors estimate that extending coverage to parents with
incomes below 200 percent of poverty would likely cost in excess of $10 billion
per year. But that extension would lead to coverage for 7.4 million, or 70 percent,
of the 10.6 million parents who are uninsured, according to the study by Lisa
Dubay and Genevieve Kenney of the Urban Institute.

They contend that Medicaid expansions would be far more effective
than premium-assistance programs and tax credits at closing the coverage gap
for poor parents. And expansions to parents could lead to better access to care
for children who are already eligible for SCHIP.

“Uninsured parents living in poverty have little access
to employer-sponsored coverage, and even if they did they would have a hard
time affording it,” said Dubay. “As it is, more than half have trouble
paying utility bills and worry about food shortages.”

Given the current fiscal situations faced by most states, the
authors contend that additional dollars from the federal government will likely
be necessary. Without those dollars, the coverage situation for parents is likely
to deteriorate further and could have a negative impact on low-income parents
and their children as well, according to the study.

The numbers of the working poor without health insurance coverage
rose from 30 percent in the late 1990s to 34 percent in 2000. In fact, the most
recent Current Population Survey data show that a third of all low-income parents
lack health insurance coverage.

Extending Coverage
to Parents May Improve Access to Care for Children

The study is one of two
released today by Health Affairs detailing the health insurance status
of working poor parents and their children. The second study, by researchers
in California, found that children of the working poor are far more likely to
be uninsured than children of nonworking poor families.

In addition, extending coverage to working poor parents could
lead to greater access to care for children. According to the authors, extending
coverage leads to children who already qualify for SCHIP obtaining more continuous
coverage and being seen regularly at a doctor’s office. According to the
authors, “public expansions in family insurance coverage are likely to
narrow disparities in access to and use of health care for children of the working
poor.”

Twenty-one percent of children of the working poor were uninsured
in 2000, as were 30 percent of their parents, according to the study conducted
by Sylvia Guendelman, professor and chair of the Maternal and Child Health Program
in the School of Public Health at the University of California, Berkeley, and
Michelle Pearl, research scientist at the Sequoia Foundation.

As would be expected, the study finds that extending insurance
coverage such as Medicaid or SCHIP to children markedly increases their access
and use of health care services. Children in families with no health insurance
coverage at all had a 19 percent higher probability than those with child-only
coverage (for example on SCHIP) of delaying or missing care because they could
not afford it. They also had a 20 percent higher probability of experiencing
unmet health care needs and a 25 percent higher probability of having no regular
source of care.

“On almost every indicator that we examined, children
with no family coverage encountered more barriers to care than children with
child-only or family coverage,” said Guendelman, lead study author. “Most
of the benefits of coverage were attributable to child coverage, however extending
coverage to the parent may further improve access by reducing breaks in coverage.”

###

Health Affairs,
published by Project HOPE, is a bimonthly multidisciplinary journal devoted
to publishing the leading edge in health policy thought and research.